MEDICARE: DR. EMILY DILTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	27616	TN

General Provider Information

NPI Number	:	1972593986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY DILTZ M.D.

Provider Business Mailing Address
First Line	:	460 MEDICAL PARK DR
Second Line	:	SUITE 103 B
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5782
Country	:	US
Telephone Number	:	865-803-6043
Fax Number	:	865-539-5936

Provider Business Practice Location Address
First Line	:	460 MEDICAL PARK DR
Second Line	:	SUITE 103 B
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5782
Country	:	US
Telephone Number	:	865-803-6043
Fax Number	:	865-539-5936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	01/24/2017

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